Wellpoint is going to roll out the WebMD PHR based system which has been working at Empire Blues (Wellchoice) for about a year to the rest of its plans to the rest of its plans. So theoretically up to 34 million people will have access to a PHR. I wrote about the WebMD solution before, so I won’t go into it much, but there are two quick points beyond the fact that (at last!) PHRs have the opportunity to go mainstream.
1) This is a vindication of the ASP model—these records live on WebMD’s servers rather than on Wellpoint’s. I never thought that the big insurers would allow another company to take their consumers’ data for fear that they would also take their consumers as well. That was certainly a concern of the plans that we were trying to sell PHRs to at i-Beacon which was why we sold enterprise software rather than an ASP service. WellMed (the company who’s PHR is the core of WebMD’s current service) was always an ASP model. And the answer is, the lowered costs of the ASP model outweigh the fear that WebMD will make it easy for another plan to assume the members data. One WebMD insider told me that they will be introducing a way to move data between plans. So the member will find “data lock” is NOT a reason to avoid moving plans, and technically they may not even have to take it off the server, assuming that WebMD is the back end for both plans. And of course potentially WebMD can start offering other health plan services and even start competing with its clients. But that’s another story.
2) Just as the private sector starts to sort this out with providers using Epic’s MyHealth to give access to the records, and WebMD starting to make real strides, CMS is starting experimentation, and Foundations are getting into the mix too with grants to help figure out what applications are needed. Are they not a bit late to the party?
And finally—it’s about bloody time!!
figured out that the way to save the $2 trillion healthcare industry – it’s for people to not get sick by getting doctors out of medicine. After spending the last few years following doctors and radiologists around, visiting cancer centers and spending time watching mice get poked and prodded, I’ve realized it is time to embed the expertise of doctors in silicon and software. Why have radiologists read mammograms to find 1 in 200 that have breast cancer? Today, a third of mammograms now have their second read done by computer, computer aided detection from companies like R2 and iCad, and for $29, much less than a radiologist, and perhaps more accurate. For me, that’s just a start. But I was astounded to learn that CT scans are on the same learning curve as PCs and iPods and cell phones. One slice per rotation moved to 4 slice, 16 slice, 64 slice and soon 256 slice CT scanners. Instead of film, the output is a high res color 3D model. Beats a blood pressure reading and cholesterol number, which is all that physicians can manage. They are flying blind.So I started running the numbers. State of the art scans are still close to $1000. Say 1% of adults have heart attacks every year. A stent procedure runs about $15,000 just for the stent, with the hospital stay and bandaids, you are in for closer to $20-30,000, let alone lost wages and productivity. Heart scans today are around $1000. So if you screen 100 people, it costs $100,000, certainly more than treating the 1 in 100 heart attack patient. So,…, Blue Cross won’t pay for scans. It is better for them if nature does their screening for them, you or I actually having a heart attack – ding, ding, ding, we found our 1 in 100.They probably still wouldn’t pay if the scans were $500. But they might at $200. And they certainly would pay at $100, because it would be cheaper to screen than to pay for care. Because it is on the silicon learning curve (down 30% every year, 50% every two years), it is pretty easy to see $100 scans within five years, probably less. Heart attacks and stroke may become a thing of the past.And cancer, the third member of the Big Three in healthcare spending? Structural CT scans will transition to molecular imaging to find cancer early. I can see biomarkers on antibody chips that can eventually sell for $1 or maybe even 10 cents can detect unique cancer proteins in blood and flag cancer early enough for much cheaper treatment, beating symptoms by five years.Doctors can’t do that. In the end, I believe that Silicon Valley will do to doctors what ATMs did to tellers.
